MEDICARE: BETH A SWEENEY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	099341	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841290335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A SWEENEY FNP

Provider Business Mailing Address
First Line	:	1001 W WORLEY ST
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2037
Country	:	US
Telephone Number	:	573-886-6711
Fax Number	:	573-814-2784

Provider Business Practice Location Address
First Line	:	1001 W WORLEY ST
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2037
Country	:	US
Telephone Number	:	573-886-6711
Fax Number	:	573-814-2784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	11/05/2019

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